Provider Demographics
NPI:1447642442
Name:MERIDIAN HEALTH
Entity type:Organization
Organization Name:MERIDIAN HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED GENETIC COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:732-776-4755
Mailing Address - Street 1:1944 ROUTE 33 STE 204
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4863
Mailing Address - Country:US
Mailing Address - Phone:732-776-4755
Mailing Address - Fax:732-776-4754
Practice Address - Street 1:1944 ROUTE 33 STE 204
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4863
Practice Address - Country:US
Practice Address - Phone:732-776-4755
Practice Address - Fax:732-776-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00100261QG0250X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics